Provider First Line Business Practice Location Address:
8942 W 24TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90034-2010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-732-1643
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2010